Paper Detail
Ruman Wang, Hangting Ye
Classifying pathological scars from clinical photographs requires distinguishing keloids from hypertrophic scars despite limited expert-labeled data and substantial acquisition variation across hospitals. End-to-end image models remain data-dependent, whereas sending photographs to a hosted vision-language model (VLM) may conflict with local data-governance requirements and yields decisions that are difficult to reproduce and audit. We introduce ScaFE (Scar Feature Engineering), which transfers clinical knowledge from a large language model (LLM) into deterministic, executable feature programs instead of asking the model to diagnose images. A web-enabled LLM retrieves clinical evidence and synthesizes programs that measure visually assessable scar attributes. Candidate programs execute in a restricted local environment, and only aggregate validation statistics and feature-level SHAP summaries are returned for iterative repair and refinement; raw images and patient-level outputs remain local. A lightweight Random Forest then operates on the resulting structured representation. On 600 photographs from three hospitals under leave-one-site-out evaluation, ScaFE achieves 81.0% site-macro balanced accuracy, exceeding the strongest baseline, BiomedCLIP, by 10.0 percentage points. With only 10% of the development data, ScaFE retains 72.0% balanced accuracy and an 11.8-point lead. Iterative refinement also raises the executable-program rate from 66.7% to 95.0%, with verified evidence for 91.7% of the final features. These results show that LLM knowledge can support data-efficient, cross-site medical image classification through local and auditable feature programs rather than direct VLM decisions.
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@article{wang2026scafe,
title = {ScaFE: Data-Efficient Scar Classification with LLM-Generated Clinical Feature Programs},
author = {Ruman Wang and Hangting Ye},
year = {2026},
abstract = {Classifying pathological scars from clinical photographs requires distinguishing keloids from hypertrophic scars despite limited expert-labeled data and substantial acquisition variation across hospitals. End-to-end image models remain data-dependent, whereas sending photographs to a hosted vision-language model (VLM) may conflict with local data-governance requirements and yields decisions that are difficult to reproduce and audit. We introduce ScaFE (Scar Feature Engineering), which transfers },
url = {https://arxiv.org/abs/2607.28538},
keywords = {cs.CV, cs.LG},
eprint = {2607.28538},
archiveprefix = {arXiv},
}
{}